Appeal those denials that result from incorrect coding edits used by payers. While many payers adopt the Medicare National Correct Coding Initiative (NCCI) edits, others determine their own coding edits. Don’t be intimidated by having to write an appeal letter. If you are billing according to correct coding conventions and have clearly documented medical justification, you are coding correctly and in compliance with standards. You should be paid for your services, and many times the only way is through an appeals process. Here are some basic tips for appealing denials.

First and foremost, check your claim to be certain it is indeed compliant with all coding guidelines and standards. Be certain that if a modifier was used to override an edit, the medical record documentation clearly supports the service and medical necessity. Understand the carrier’s appeals process and appeal within its timeliness guidelines.

Format the letter to include the name...

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